First line treatment selection modifies disease course and long-term clinical outcomes in Mycobacterium avium complex pulmonary disease
Abstract The combination of rifamycin (RFP), ethambutol (EB), and macrolides is currently the standard regimen for treatment of Mycobacterium avium complex pulmonary disease (MAC-PD). However, poor adherence to the standardized regimens recommended by current guidelines have been reported. We undert...
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| Format: | Article |
| Language: | English |
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Nature Portfolio
2021-01-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-021-81025-w |
| _version_ | 1818840896386367488 |
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| author | Kiyoharu Fukushima Seigo Kitada Sho Komukai Tomoki Kuge Takanori Matsuki Hiroyuki Kagawa Kazuyuki Tsujino Mari Miki Keisuke Miki Hiroshi Kida |
| author_facet | Kiyoharu Fukushima Seigo Kitada Sho Komukai Tomoki Kuge Takanori Matsuki Hiroyuki Kagawa Kazuyuki Tsujino Mari Miki Keisuke Miki Hiroshi Kida |
| author_sort | Kiyoharu Fukushima |
| collection | DOAJ |
| description | Abstract The combination of rifamycin (RFP), ethambutol (EB), and macrolides is currently the standard regimen for treatment of Mycobacterium avium complex pulmonary disease (MAC-PD). However, poor adherence to the standardized regimens recommended by current guidelines have been reported. We undertook a single-centred retrospective cohort study to evaluate the long-term outcomes in 295 patients with MAC-PD following first line treatment with standard (RFP, EB, clarithromycin [CAM]) or alternative (EB and CAM with or without fluoroquinolones (FQs) or RFP, CAM, and FQs) regimens. In this cohort, 80.7% were treated with standard regimens and 19.3% were treated with alternative regimens. After heterogeneity was statistically corrected using propensity scores, outcomes were superior in patients treated with standard regimens. Furthermore, alternative regimens were significantly and independently associated with sputum non-conversion, treatment failure and emergence of CAM resistance. Multivariate cox regression analysis revealed that older age, male, old tuberculosis, diabetes mellitus, higher C-reactive protein, and cavity were positively associated with mortality, while higher body mass index and M. avium infection were negatively associated with mortality. These data suggest that, although different combination regimens are not associated with mortality, first line administration of a standard RFP + EB + macrolide regimen offers the best chance of preventing disease progression in MAC-PD patients. |
| first_indexed | 2024-12-19T04:17:28Z |
| format | Article |
| id | doaj.art-3a2e1baa63ee4ff4a81f0ec6b2a4718d |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-12-19T04:17:28Z |
| publishDate | 2021-01-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj.art-3a2e1baa63ee4ff4a81f0ec6b2a4718d2022-12-21T20:36:15ZengNature PortfolioScientific Reports2045-23222021-01-0111111010.1038/s41598-021-81025-wFirst line treatment selection modifies disease course and long-term clinical outcomes in Mycobacterium avium complex pulmonary diseaseKiyoharu Fukushima0Seigo Kitada1Sho Komukai2Tomoki Kuge3Takanori Matsuki4Hiroyuki Kagawa5Kazuyuki Tsujino6Mari Miki7Keisuke Miki8Hiroshi Kida9Department of Respiratory Medicine, National Hospital Organization, Osaka Toneyama Medical CentreDepartment of Respiratory Medicine, Yao Tokushukai General HospitalDepartment of Biomedical Statistics, Graduate School of Medicine, Osaka UniversityDepartment of Respiratory Medicine, National Hospital Organization, Osaka Toneyama Medical CentreDepartment of Respiratory Medicine, National Hospital Organization, Osaka Toneyama Medical CentreDepartment of Respiratory Medicine, National Hospital Organization, Osaka Toneyama Medical CentreDepartment of Respiratory Medicine, National Hospital Organization, Osaka Toneyama Medical CentreDepartment of Respiratory Medicine, National Hospital Organization, Osaka Toneyama Medical CentreDepartment of Respiratory Medicine, National Hospital Organization, Osaka Toneyama Medical CentreDepartment of Respiratory Medicine, National Hospital Organization, Osaka Toneyama Medical CentreAbstract The combination of rifamycin (RFP), ethambutol (EB), and macrolides is currently the standard regimen for treatment of Mycobacterium avium complex pulmonary disease (MAC-PD). However, poor adherence to the standardized regimens recommended by current guidelines have been reported. We undertook a single-centred retrospective cohort study to evaluate the long-term outcomes in 295 patients with MAC-PD following first line treatment with standard (RFP, EB, clarithromycin [CAM]) or alternative (EB and CAM with or without fluoroquinolones (FQs) or RFP, CAM, and FQs) regimens. In this cohort, 80.7% were treated with standard regimens and 19.3% were treated with alternative regimens. After heterogeneity was statistically corrected using propensity scores, outcomes were superior in patients treated with standard regimens. Furthermore, alternative regimens were significantly and independently associated with sputum non-conversion, treatment failure and emergence of CAM resistance. Multivariate cox regression analysis revealed that older age, male, old tuberculosis, diabetes mellitus, higher C-reactive protein, and cavity were positively associated with mortality, while higher body mass index and M. avium infection were negatively associated with mortality. These data suggest that, although different combination regimens are not associated with mortality, first line administration of a standard RFP + EB + macrolide regimen offers the best chance of preventing disease progression in MAC-PD patients.https://doi.org/10.1038/s41598-021-81025-w |
| spellingShingle | Kiyoharu Fukushima Seigo Kitada Sho Komukai Tomoki Kuge Takanori Matsuki Hiroyuki Kagawa Kazuyuki Tsujino Mari Miki Keisuke Miki Hiroshi Kida First line treatment selection modifies disease course and long-term clinical outcomes in Mycobacterium avium complex pulmonary disease Scientific Reports |
| title | First line treatment selection modifies disease course and long-term clinical outcomes in Mycobacterium avium complex pulmonary disease |
| title_full | First line treatment selection modifies disease course and long-term clinical outcomes in Mycobacterium avium complex pulmonary disease |
| title_fullStr | First line treatment selection modifies disease course and long-term clinical outcomes in Mycobacterium avium complex pulmonary disease |
| title_full_unstemmed | First line treatment selection modifies disease course and long-term clinical outcomes in Mycobacterium avium complex pulmonary disease |
| title_short | First line treatment selection modifies disease course and long-term clinical outcomes in Mycobacterium avium complex pulmonary disease |
| title_sort | first line treatment selection modifies disease course and long term clinical outcomes in mycobacterium avium complex pulmonary disease |
| url | https://doi.org/10.1038/s41598-021-81025-w |
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